Provider Demographics
NPI:1851800718
Name:LUE, LISA ROMONA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ROMONA
Last Name:LUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 HIKINA LN APT 2
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4538
Mailing Address - Country:US
Mailing Address - Phone:808-757-9434
Mailing Address - Fax:808-443-5183
Practice Address - Street 1:918 HIKINA LN APT 2
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4538
Practice Address - Country:US
Practice Address - Phone:808-757-9434
Practice Address - Fax:808-443-5183
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA$$$$$$$$$OtherPRIVATE INSURANCE